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Turning Up the Heat on Health Care Fraud

Newt Gingrich, insurance and law enforcement experts propose ways to save the government billions

Newt Gingrich at the Member Event in Orlando, FL on October 1, 2010.

Oct. 1, 2010: Newt Gingrich at the AARP member event. — Andrew Kaufman

With health care fraud — particularly in Medicare and Medicaid — costing the nation upward of $100 billion annually, political experts like former House Speaker Newt Gingrich and government officials want citizens on the front lines of prevention.

"If you get a wheelchair billed in your name, you send a note back to the paying institution saying: 'Wait a second, I didn't get a wheelchair.' That will help prevent fraud."

"As long as you are not involved, the crooks will always have the advantage," Gingrich said.

Gingrich, Blue Cross/Blue Shield President Scott Serota and Ryan Lynch, a fraud investigator for the inspector general of the Department of Health and Human Services, appeared at AARP's "Orlando@50+" conference Friday to discuss the magnitude of health care fraud in a session titled "Turning Up the Heat: Fighting Health Fraud Together."

"You are the front lines, you are real time, you understand what is happening and you can help," Serota told the Florida audience of several hundred people. "Notify us and we can act quickly to solve these problems."

Credit card model

The government is already cracking down by setting new regulations aimed at keeping better track of health care providers, especially those who provide medical equipment and supplies, and new home-health agencies, the sources of much of the fraud. Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius have said their most recent initiative, launched in 2009, has produced more than 580 criminal convictions and recovered more than $2.5 billion. But more remains to be done.

Gingrich said that people need to check their "explanation of benefits" forms and Medicare summary notices carefully, and he called for a system that lets consumers know in real time what services and equipment are being billed in their names.

He said health care transactions should be like credit card transactions — when the credit card company notices something out of the ordinary on charges and calls within hours. "We need to reengage the customer, the citizen, the patient with a real-time verification system," he said.

He likened the consumer's responsibility to a trip to a McDonald's drive-through window that his wife, Callista, made recently, in which she was so preoccupied with work that she drove off without her order. When she noticed the mistake, minutes later, she returned to the window and the clerk tossed in an order of fries as compensation for Callista's harried day. He told the story to laughter from the several hundred spectators attending the session, but his point was that the farther "away from the window" we get in health care, the more the crooks have the advantage.

"We need a billing system in which you know what's being billed," he said. "If you get a wheelchair billed in your name, you send a note back to the paying institution saying: 'Wait a second, I didn't get a wheelchair.' " That will help prevent fraud, he said.

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